Journal of Emergency Medicine最新文献

{"title":"Is Intravenous Contrast Associated with Increased Risk of Acute Kidney Injury?","authors":"Brit Long MD ,&nbsp;Samuel M. Keim MD, MS ,&nbsp;Michael Gottlieb MD ,&nbsp;Steven G. Schauer DO, MS ,&nbsp;Gillian Schmitz MD","doi":"10.1016/j.jemermed.2024.11.013","DOIUrl":"10.1016/j.jemermed.2024.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Computed tomography (CT) is a common imaging modality used in the emergency department. Intravenous (i.v.) contrast can assist with visualization of pathology, particularly for inflammatory conditions and vascular structures. However, i.v. contrast has historically been associated with the risk of acute kidney injury (AKI).</div></div><div><h3>Clinical Question</h3><div>Is i.v. contrast associated with an increased risk of AKI?</div></div><div><h3>Evidence Review</h3><div>Studies retrieved included four systematic reviews and meta-analyses evaluating the use of i.v. contrast for CT and association with AKI, need for kidney replacement therapy, and mortality. These studies provide estimates of the potential association of AKI with use of i.v. contrast for CT.</div></div><div><h3>Conclusion</h3><div>Based upon the available literature, the use of i.v. contrast for CT imaging does not seem to be associated with an increased risk of AKI.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 129-136"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Euglycemic Hyperosmolar Hypernatremic State: A Variant Subtype of Traditional Hyperosmolar Hyperglycemic State With Higher Mortality","authors":"Siyuan Cao MD ,&nbsp;Bijay Yadav MD ,&nbsp;Lihong Huo MD ,&nbsp;Robert Bagdasaryan MD ,&nbsp;Shanjin Cao MD, PhD","doi":"10.1016/j.jemermed.2024.12.001","DOIUrl":"10.1016/j.jemermed.2024.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Hyperosmolar hyperglycemic state (HHS) is a serious and potentially life-threatening complication of diabetes, defined by serum glucose &gt;600 mg/dL and effective osmolality &gt;320 mOsm/kg. However, some patients present with hyperglycemia (serum glucose levels ≥180 mg/dL but &lt;600 mg/dL), hypernatremia, and effective osmolality &gt;320 mOsm/kg. We refer to this subtype of HHS as euglycemic hyperosmolar hypernatremic state.</div></div><div><h3>Objective</h3><div>We aimed to investigate its clinical characteristics compared to traditional HHS.</div></div><div><h3>Methods</h3><div>A retrospective observational study of consecutive adult patients with diabetes and effective osmolality &gt;320 mOsm/kg admitted between January 2021 and February 2023 in a single medical institution. The study analyzed age, sex, hemoglobin A1c (HbA1c), serum glucose, serum sodium, effective osmolality, and mortality of encounters of euglycemic hyperosmolar hypernatremic state and traditional HHS.</div></div><div><h3>Results</h3><div>We encountered 34 cases of euglycemic hyperosmolar hypernatremic state and 19 cases of traditional HHS. Patients with euglycemic hyperosmolar hypernatremic state were older, had less severe diabetes with lower baseline HbA1c, worse hypernatremia, lower effective osmolality, and higher mortality (35.3 % vs. 0 %; <em>p</em> = 0.002) compared to patients with traditional HHS. Euglycemic hyperosmolar hypernatremic state had a similarly high mortality rate as hypernatremia alone.</div></div><div><h3>Conclusions</h3><div>Euglycemic hyperosmolar hypernatremic state is a variant subtype of HHS. It shares the same pathophysiological mechanisms as traditional HHS but is associated with higher mortality, thus warranting increased recognition as it requires similar treatment strategy as traditional HHS.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 25-30"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Male With Wrist Pain","authors":"Branden Kahen DO ,&nbsp;Alexander Song MD ,&nbsp;Amin Mohamadi MD ,&nbsp;Josh Greenstein MD ,&nbsp;Barry Hahn MD","doi":"10.1016/j.jemermed.2024.11.005","DOIUrl":"10.1016/j.jemermed.2024.11.005","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 87-88"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Community-Based Integrated Healthy Aging Program at a Tertiary Hospital (YASAM) for the Oldest Old Participants May have the Potential to Reduce Emergency Admission: Preliminary Evidence from a Pre–Post-Intervention Study","authors":"Bilal Katipoglu M.D. ,&nbsp;Suleyman Emre Kocyigit M.D. ,&nbsp;Ugur Ergun M.D. ,&nbsp;Abdullah Osman Kocak M.D. ,&nbsp;Ozkan Aydeniz M.D. ,&nbsp;Ismail Mert M.D. ,&nbsp;Serkan Kadir Keskin MD.","doi":"10.1016/j.jemermed.2024.12.009","DOIUrl":"10.1016/j.jemermed.2024.12.009","url":null,"abstract":"<div><h3>Background</h3><div>Frail, oldest old individuals living in the community frequently face obstacles when trying to access outpatient clinics, which results in a higher dependence on emergency departments. This trend highlights the need for improved accessibility and support services for this vulnerable population.</div></div><div><h3>Objectives</h3><div>This study aims to investigate the relationship between community-based integrated healthy aging program in tertiary hospital and healthcare utilization among the oldest old adults.</div></div><div><h3>Methods</h3><div>A before-after pilot intervention prospective study was conducted between June 2023 and December 2023. The YASAM conducted a comprehensive assessment, including the Mini-Cog, Mini Mental Status Assessment, Mini Nutrition Assessment (short form), and Geriatric Depression (Yesavage) scale, as well as the Time-up and Go test and Stand-Chair tests. Health service utilization, including emergency visits, hospitalizations, and outpatient clinic visits, was documented after and before the index date for the participants.</div></div><div><h3>Results</h3><div>The study included 312 participants, with a mean age of 85.8 ± 3.9 years. The proportion of individuals with mild cognitive impairment was 55.8 % (<em>n</em> = 159). The percentage of participants with possible sarcopenia was 43.3 % (<em>n</em> = 135), and the percentage of those with moderate or severe frailty was 53.8 % (<em>n</em> = 163). The average visits to the emergency department per month before the index date were lower than after the index date, and this difference was significant (<em>p</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>Policymakers should consider expanding community-based integrated healthy aging programs in tertiary hospitals to meet the growing healthcare needs of older adults.</div></div><div><h3>Trial registration</h3><div>The trial was prospectively registered at ClinicalTrials.gov. Identifier: NCT05993572 Registered on 15 July 2023.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 112-120"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143911500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation-Based Resuscitative Transesophageal Echocardiography Training for Emergency Medicine Residents","authors":"Andrew Fried MD ,&nbsp;Jessica A. Hathaway MD ,&nbsp;Tania Strout PHD, RN, MS ,&nbsp;David C. Mackenzie MD ,&nbsp;Peter E. Croft MD ,&nbsp;Christina N. Wilson MD ,&nbsp;August M. Felix MD","doi":"10.1016/j.jemermed.2024.11.006","DOIUrl":"10.1016/j.jemermed.2024.11.006","url":null,"abstract":"<div><h3>Background</h3><div>Transesophageal echocardiography (TEE) is an emerging resuscitation tool in emergency medicine. Simulation-based training is necessary for teaching this skill set. There has been no evaluation of how simulation prepares emergency medicine (EM) residents to perform this skill in live patients.</div></div><div><h3>Objectives</h3><div>The objective of this study is to evaluate competency following simulation training and performance of resuscitative TEE on live patients in the operating room (OR).</div></div><div><h3>Methods</h3><div>A prospective study at a single academic site, enrolling volunteer postgraduate year (PGY)2 and PGY3 EM residents. Residents underwent the following: Pretest examination to assess general TEE knowledge; 30-minute lecture on a resuscitative protocol: mid-esophageal four-chamber (ME4C), mid-esophageal long axis (MELAX), trans-gastric short axis (TGSAX) and ascending aortic short axis (AscAoSAX); Two 1-hour sessions with a HeartWorks TEE simulator led by a physician trained in resuscitative TEE; post-test examination; TEE examination in the OR with a cardiac anesthesiologist. Data were summarized with descriptive statistics. Test scores were compared with paired <em>t</em>-test or Wilcoxon rank-sum tests.</div></div><div><h3>Results</h3><div>Fifteen residents participated. The pretest mean score was 11.07, 95% CI: 9.35 to 12.79. The post-test mean score was 19.40, 95% CI: 18.94 to 19.86. A significant difference in scores was noted, <em>t</em> = –11.996, <em>p</em> &lt; 0.0001. The OR assessment findings included: number of placement attempts (mean: 1.27; 95% CI: 1.01–1.52); clinically acceptable views (ME4C 93.3%, MELAX 93.3%, AscAoSAX 60%, and TGSAX 60%). Of 60 total views, 76.7% were acceptable.</div></div><div><h3>Conclusion</h3><div>Simulation training in resuscitative TEE is an effective method for preparing EM residents to obtain and interpret TEE imaging in a live patient.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 89-96"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143911501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"Edward J. Otten MD, FACMT, FAWM","doi":"10.1016/j.jemermed.2024.11.011","DOIUrl":"10.1016/j.jemermed.2024.11.011","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 142-143"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Gender Identity and Underrepresented-In-Medicine Identity on Emergency Medicine Resident Feedback","authors":"Ryan F. Coughlin MD ,&nbsp;Jessica Bod MD ,&nbsp;Shacelles Bonner MD ,&nbsp;Katarzyna Gore MD ,&nbsp;Alina Tsyrulnik MD ,&nbsp;Dylan Devlin MD ,&nbsp;Nickolas Srica MD ,&nbsp;David Della-Giustina MD ,&nbsp;Manali Phadke MS ,&nbsp;James Dziura PhD ,&nbsp;Katja Goldflam MD ,&nbsp;Michael Gottlieb MD","doi":"10.1016/j.jemermed.2024.11.019","DOIUrl":"10.1016/j.jemermed.2024.11.019","url":null,"abstract":"<div><h3>Background</h3><div>Effective delivery of feedback is critical to enhancing learning, clinical performance, and professional growth among residents. However, disparities may exist in how feedback is given to different learner groups.</div></div><div><h3>Objective</h3><div>To determine if resident gender or underrepresented–in medicine (UiM) identity influenced the likelihood of receiving feedback.</div></div><div><h3>Methods</h3><div>This was a retrospective study of feedback delivery at an academic, 4-year, emergency medicine residency over a 28-month period. Generalized estimating equation models were performed to assess the odds of receiving feedback, feedback delivery, feedback content, or use of deliberate practice with respect to resident and assessor gender identity and UiM identity, or resident-assessor gender identity or UiM identity concordance.</div></div><div><h3>Results</h3><div>Resident gender identity (OR 0.96; 95% CI 0.84–1.11) and UiM identity (OR 1.02; 95% CI 0.81–1.27) were not associated with differences in receiving written feedback. Analysis among those who received face-to-face feedback revealed no significant differences in feedback delivery method by gender (OR 1.13; 95% CI 0.83–1.52) or UiM identity (OR 1.40; 95% CI 0.97–2.02). There were no significant differences in the use of deliberate practice (gender OR 0.94; 95% CI 0.81–1.09 and UiM OR 1.009; 95% CI 0.77–1.33). Neither faculty-resident gender concordance (OR 0.95; 95% CI 0.83–1.08) nor faculty-resident UiM concordance (OR 1.07; 95% CI 0.92–1.24) were significantly associated with receiving written feedback.</div></div><div><h3>Conclusion</h3><div>In this single-center, retrospective study, there were no significant differences in the odds of receiving feedback, feedback delivery, self-reported feedback content, or use of deliberate practice with respect to resident gender identity and resident UiM identity, or resident-faculty gender or UiM concordance. Further research with larger, multisite datasets is needed to draw more definitive conclusions regarding disparities in these areas on a larger scale.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 97-103"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous QTc Monitoring for Patients Intoxicated with QTc Prolonging Medication in the Emergency Department: A Proof of Principle Study","authors":"Marit Bot MSC ,&nbsp;Raymond J. van Wijk MSC ,&nbsp;Hermie J. Hermens PHD ,&nbsp;David N. van der Kooi BSC ,&nbsp;Thomas Luttmer BSC ,&nbsp;Eva M. Boetje BSC ,&nbsp;Jan C. ter Maaten MD, PHD ,&nbsp;Hjalmar R. Bouma MD, PHD ,&nbsp;Ewoud ter Avest MD, PHD","doi":"10.1016/j.jemermed.2024.11.007","DOIUrl":"10.1016/j.jemermed.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>It can be challenging to determine when patients presenting with an overdose of QT interval prolonging drugs can be discharged safely, especially when the moment of intoxication or the substance ingested is unknown.</div></div><div><h3>Objective</h3><div>In a proof of principle study, we aimed to determine whether continuous corrected QT interval (QTc) analysis can be used to establish optimal observation duration of patients intoxicated with QTc prolonging medication.</div></div><div><h3>Methods</h3><div>For patients presenting with an intoxication with QT interval prolonging drugs in the emergency department, electrocardiography signals sampled at 500 Hz were preprocessed and the mean heart rate QTc per 5 min was calculated and plotted against time. A third order polynomial was fitted to visualize when the QTc would be highest (i.e., electrophysiological time to maximum concentration [T_max]). This point in time was compared with the estimated T_max based on pharmacokinetic properties of the ingested substance.</div></div><div><h3>Results</h3><div>In a retrospective biobank-based study, a total of 22 emergency department visits (of 15 patients) were analyzed. An electrophysiological T_max could be calculated for 17 of 22 visits. The remaining 5 patients presented either long after the electrophysiological T_max (n = 4) or were admitted to the ward before reaching the T_max (n = 1). The mean (SD) difference between the estimated T_max based on drug properties and the calculated electrophysiological T_max was 18 (133) min (range –158 to 296 min). Despite the wide range, there was a significant correlation between recorded electrophysiological T_max and estimated T_max (<em>r</em> = 0.67, <em>p</em> = 0.012).</div></div><div><h3>Conclusions</h3><div>Continuous electrophysiological monitoring can be used as an adjunct to determine the toxicokinetic T_max for patients presenting with an intoxication, especially when the time of ingestion or the substance ingested is unknown.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 46-55"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the Utility of Point-of-Care Ultrasound for Diagnosis of Soft Tissue Abscess vs. Cellulitis?","authors":"Kristine Jeffers MD ,&nbsp;Samuel M. Keim MD, MS ,&nbsp;Brit Long MD ,&nbsp;Michael Gottlieb MD ,&nbsp;Srikar R. Adhikari MD, MS","doi":"10.1016/j.jemermed.2024.11.012","DOIUrl":"10.1016/j.jemermed.2024.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Skin and soft tissue infections (SSTIs) including cellulitis and abscess are common conditions managed in the emergency department, but differentiating these on history and physical examination alone can be challenging. Point-of-care ultrasound (POCUS) has been proposed as a tool to distinguish abscess from cellulitis.</div></div><div><h3>Clinical Question</h3><div>What is the utility of POCUS for diagnosing soft tissue abscess vs. cellulitis?</div></div><div><h3>Evidence Review</h3><div>Studies retrieved included four systematic reviews and meta-analyses evaluating the use of POCUS for diagnosing abscess. These studies provide estimates of the potential utility of POCUS in differentiating abscess and cellulitis.</div></div><div><h3>Conclusion</h3><div>Based upon the available literature, POCUS can reliably differentiate abscess and cellulitis and assist with management of SSTIs.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 121-128"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(25)00166-0","DOIUrl":"10.1016/S0736-4679(25)00166-0","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"72 ","pages":"Pages 144-145"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}